iPsychology

Difference between a Psychologist and a Psychiatrist

The short answer is, psychiatrists are medical doctors and psychologists are not. The suffix "-iatry" means "medical treatment," and "-logy" means "science" or "theory." So psychiatry is the medical treatment of the psyche, and psychology is the science of the psyche. Because psychiatrists are trained medical doctors, they can prescribe medications, and they spend much of their time with patients on medication management as a course of treatment.

Psychologists focus extensively on psychotherapy and treating emotional and mental suffering in patients with behavioral intervention. Psychologists are also qualified to conduct psychological testing, which is critical in assessing a person's mental state and determining the most effective course of treatment.

Their Credentials

Psychiatrists begin their careers in medical school. After earning their MD, they go on to four years of residency training in mental health, typically at a hospital's psychiatric department.According to Marcia Goin, MD, past-president of the American Psychiatric Association and a clinical professor of psychiatry at the University of Southern California, psychiatric residencies include a range of subspecialized training, such as working with children and adolescents. After completing their residency, these physicians can be licensed to practice psychiatry. Psychologists go through five to seven years of academic graduate study, culminating in a doctorate degree. They may hold a PhD or a PsyD. Those who are mainly interested in clinical psychology -- treating patients as opposed to focusing on research -- may pursue a PsyD. Licensing requirements for psychologists vary from state to state, but at least a one- or two-year internship is required to apply for a license to practice psychology.

Prescribing Powers

As medical doctors, psychiatrists can do what most psychologists in the United States cannot: They can prescribe drugs. Recently the state of Louisiana allowed psychologists to write prescriptions after consulting with a psychiatrist, joining the state of New Mexico, which allowed psychologists to begin prescribing in 2002. A common misconception about psychiatrists is that they only treat people with severe mental illness, like schizophrenia or bipolar disorder, diseases for which medication is the mainstay of treatment, leaving psychotherapy to psychologists and patients with less severe problems.

Psychiatrists who work at clinics and hospitals certainly see many hard cases. "The major patients they see are severely mentally ill, but there are others who are not," Goin tells WebMD. She says she practices a lot of psychotherapy in her private office and that most of her patients there are not on medication.Increasingly, however, psychiatrists in private practice spend their time with medication management and not psychotherapy. Other mental health providers usually do therapy sessions, and when they see a patient who could benefit from medication, they send the patient to a psychiatrist for an evaluation and possibly a prescription.

Psychologists and psychiatrists tend to hate each other. The reasons are historical: beginning even before Freud, psychologists held enormous power over the cultural imagination. The whole idea of psychiatry — an explicitly chemical rather than behavioral treatment of the mind — didn’t start until the industrial age, and for a long time afterward, psychiatrists were held in disregard.

Friday morning, psychiatrists take a bit of revenge. Even after years of symposia and papers designed to reconnect the two tendril branches of mental-health treatment, the American Psychiatric Association has released new guidelines for treatment of depression that still denigrate the cognitive and behavioral approaches of the American Psychological Association. Both organizations are called A.P.A., and neither will relinquish the shortened form to the other. Yeah, it turns out the nation’s mental-health leaders act like children.

According to the new guidelines — which will govern treatment for the 200,000 in-patient psychiatric patients in the U.S., as well as the 20 million or so who get out-patient treatment — the No.-1 preferred approach is drugs. Just drugs. The guidelines don’t mention psychological approaches like cognitive-behavioral therapy until No. 3, just after electroshock therapy.

The new guidelines underplay an enormous body of data from the past decade showing that even the best psychiatric drugs work better than sugar pills only when the drugs are used in conjunction with psychological therapies that help patients change how they behave and how they form their thoughts. Neither a strictly psychiatric approach (just drugs) nor a strictly psychological approach (just talk therapy) works much better than a placebo pill on its own. But when used in combination, the psychiatric and psychological treatments help a majority of people get better.

So why can’t A.P.A. and A.P.A. get along?

One reason is a problem of data. The new American *Psychiatric* guidelines released today conflate several psychotherapy approaches equally because at least one or two randomized trials has shown them to be effective. But cognitive-behavioral therapy has a huge base of evidence compared to rather obscure approaches such as interpersonal therapy. In the context of national guidelines that will shape the treatment of millions, it borders on quackery to include cognitive-behavioral therapy in the same sentence that the A.P.A. (Psychiatric) calls “problem-solving therapy.”

When I spoke with an A.P.A. (Psychiatric) official Thursday night, he declined to speak on the record. He referred me to an official statement the organization released, which says it “reviewed more than 10,000 studies,” revealed all ties to pharmaceutical companies, and will consider any comments to revise the guidelines. I only have one comment: the A.P.A. and the A.P.A. should start with becoming Facebook friends. Psychology and psychiatry shouldn’t be enemies.